Provider Demographics
NPI:1326055179
Name:HABIB, MOHAMMAD ALI (MD)
Entity Type:Individual
Prefix:MR
First Name:MOHAMMAD
Middle Name:ALI
Last Name:HABIB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:MOHAMMAD
Other - Middle Name:ALI
Other - Last Name:HABIBZADEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11045 N 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4816
Mailing Address - Country:US
Mailing Address - Phone:602-944-4474
Mailing Address - Fax:602-331-5076
Practice Address - Street 1:11045 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4816
Practice Address - Country:US
Practice Address - Phone:602-944-4474
Practice Address - Fax:602-331-5076
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13473207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
D36926Medicare UPIN